Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT Do New Complications Develop during Puberty after Childhood Hypospadias Repair?

By: Warren Snodgrass, MD; Nicol Bush, MD, MCS | Posted on: 01 Sep 2022

Snodrass W, Bush N. Do new complications develop during puberty after childhood hypospadias repair? J Urol. 2022;208(3)696-701.

Study Need and Importance

Some have speculated that penile growth, erectile forces and sexual activity during puberty can create new complications after successful childhood hypospadias repair, leading to recommendations that followup should continue until growth is completed. Worry about late complications requiring more surgery also persuades some caregivers that repair should be delayed until puberty is complete, which exposes patients to functional and body image concerns arising from uncorrected hypospadias. Furthermore, the potential for late complications years after repair may cause surgeons to question the validity of reports with followup that ends before puberty. The goal of this study was to determine if new complications develop during puberty after childhood hypospadias repair.

What We Found

There was a bimodal distribution of complications in this series of 82 Tanner 2-5 patients following childhood hypospadias repair (see Figure). Most (85%) occurred before puberty, including all cases of ventral curvature and dehiscence, 10 of 12 fistulas and a third of strictures. A second, smaller group (15%) presented well after puberty in middle age, all with strictures or meatal stenosis. Only 5% reported symptoms that began during puberty, 2 with fistulas and 2 with strictures.

“Worry about late complications requiring more surgery also persuades some caregivers that repair should be delayed until puberty is complete, which exposes patients to functional and body image concerns arising from uncorrected hypospadias.”

Limitations

Our study relied on patient recall to determine when complications were first noted, but it is unlikely that recall bias significantly influenced our observations. All those reporting onset in childhood stated unequivocally that their symptoms were present long before puberty. Men presenting in middle age with new obstructive symptoms said those began recently, well after puberty. That left only a few who de scribed the onset of a complication during puberty.

Figure. Among 82 consecutive Tanner 2-5 males presenting for hypospadias reoperation, the complication occurred before puberty in 86%, during puberty in 5%, and after puberty in 15%—primarily obstructive voiding symptoms from urethral stricture/meatal stenosis at an average age of 47 years.

“These findings should reassure caregivers that successful childhood hypospadias repairs have little risk for complications developing during puberty.”

Interpretation for Patient Care

Most complications after childhood hypospadias repair occurred before puberty, with a lesser number diagnosed in middle age. Only 5% had the onset of a new complication during puberty, with none presenting with new penile curvature or dehiscence, and only 2 with a fistula. These findings should reassure caregivers that successful childhood hypospadias repairs have little risk for complications developing during puberty. They also demonstrate that followup to detect all complications would have to be lifelong.